Tuesday, December 23, 2008

Living in a town to which "The Reader," "The Wrestler," or even "Milk" have not yet arrived, I recently found myself, encouraged by friends and by the casting of Will Smith, at a movie I might otherwise have missed. Despite murmurings of a "twist," I found it very predictable (the movie, after all, opens with Smith telling you what his plans are, and then unfolds quite clearly with his guilt in flashbacks, and, in others, with cancer, and renal failure, and heart trouble, and blindness) and so I was more than a little shocked to hear so much sniffling around me. Sure, as guest Nancy Merchand stated in an episode of TV's Homicide: Life on the Street (and I may be paraphrasing) "A rare gesture in an uncivilized world," but do people not even consider what anti-gift the impact of suicide has on those around them? And when a man gives his heart to a woman, isn't the romance lost when this is concretized? To kiss becomes cruel.Shylock demands his pound of flesh, but Smith's character seems to believe seven pounds are required for recompense of seven deaths. While some have said this film is about the search for redemption, I agree with Rafer Guzman that the film is morally confused. Each has the right to seek his own path, but guilt, grief, and depression all demand treatment, not idealization. Director Gabriele Muccino and writer Grant Nieporte missed the boat on this one. And did others miss that the brother accused Smith of taking something from him, or that Smith had made money as an aeronautics engineer? I, too, may have missed the boat on this movie, or, at least, wished I missed the boat to the movie theater.

Wednesday, November 5, 2008

I was struck by the poignant remarks of Democratic strategist, Donna Brazile, whose home in DC is along the walking path to the home of Fredrick Douglas, a former slave, abolitionist and woman’s suffragist. Brazile’s home is close as well to the capital building where the 44th President of the United States of America will take his oath of office in January 2009. She noted that that the steps of the capital were built by enslaved Africans. Last year, Congress passed a bill to name the Capitol Visitor Center Room “Emancipation Hall” to commemorate the contribution of the enslaved workers. Donna said that she envisioned that those workers laid each brick with skill and optimism and in January, their hope will be made manifest.

I was also struck by a news reporter who saw the source of the enthusiasm of the governments world-wide to work with an Obama-led America to their anticipation that they will be able to become partners in the work. Higher education researchers tell us that employers want their college-educated workers to master 21st century skills,” aka, “soft skills.” Soft skills are certainly familiar to the psychoanalytic community—collaboration, inclusion, analysis, collectivity, mutuality, engagement, listening, creativity in problem solving and so on. The world leaders and those they lead seek and anticipate having their voices and visions not only at the table, but empowered to speak and shape our collective future.

Sunday, October 26, 2008

Dis-aggregation; and Dis-connectionDe-personalization; De-realization; and De-contextualizationThe most provocative part of any presentation is, for me, the clinical, which, in addition to who says (left-brain) what to whom, includes relationship, the implicit, and, a lot of right-brain knowing, and not-knowing. For ethical reasons, I can only marginally report on who says what to whom. Still, discussing ideas, not a particular case, excitedly lights up the curious brain.

On October 25, 2008 Richard A. Chefetz, MD, from New Directions in Psychoanalysis at the Washington Psychoanalytic Foundation, and the Advanced Psychoanalytic Training of the Washington School of Psychiatry opened the Trauma Series Workshop of the Tampa Bay Institute for Psychoanalytic Studies, Inc with a paper on Dissociation. Chefetz used Bucci's definition of dissociation: the unlinking of normally associated elements of experience that nonetheless remain unconsciously, implicitly, bound and related. This unlinking is facilitated by failure of the brain to formulate referential connections between different elements of experience, the failure to provide the context necessary to [more]accurately interpret experience.

While dissociation is part of normal mental function, e.g. highway hypnosis, or the fact that the brain selectively allows little, at any one time, into conscious awareness, when the right (amygdala) brain is overwhelmed with emotion, the left brain (Broca's area) is hypoperfused such that the experience cannot be linked to potentially helpful narrative. In fact, during intense emotion, e.g. intense fright, one can be rendered literally speechless (a fact that can be used didactically-cognitively to vitiate the guilt of a survivor who could not protest at the time of the abuse and victimization). Right brain hyperactivity can intensify vulnerability and aggravate trauma by denying it symbolization through narrative. (Likewise, when the left brain is busy, we tend to notice less our painful feelings and bodily sensations.)

Trauma is an experience that changes one's world view, one's self view, one's subjectivity (a person's interpretation of thoughts, feelings, and sensations). The dissociative process protects the self from trauma, from, e.g. the disparate elements of both loving and fearing the unpredictable caretaker. But its fallout includes severely limiting one's affective capacity and it creates incoherence, coherence being necessary for self regulation.

Isolated affect, an attempt at regulation, is dissociation that maintains attachment. A child accommodates to prevent the needed caretaker's withdrawal. Security, i.e. sameness -what is predictable, coherent, familiar- is sought, even if it is painful, creates deadness, or requires the disappearance of the self. Chefetz notes that a therapist, by being helpful, can cause a shift in a patient's self state, from child to adult, but then, the adult, believing only children need (and get) help, paradoxically, goes into a panic.

Dissociative Identity ("multiple personality") Disorder challenges the therapist's idea of a unified, cohesive self. We are likewise challenged to tolerate our own varying self states, and our capacity, as well as the patient's, for anger, rage, sadism, collusion. Can we, for example, explore with the patient her/his request for physical closeness and sexual contact, its meaning, its potential betrayal if acted upon, and can we be trusted to set and maintain appropriate boundaries? Will we deny this capacity in ourselves and insist on being the 'rescuer,' or withdraw, or lose all awareness of the ways we are sadistic?

Chefetz reminds us to be be curious and open about what we are feeling in a given moment, and to remain 'experience near.' I will, on January 10, 2009 in Part II of the Trauma Workshop Series, talk more about dissociation, both in the therapist and patient, how to navigate and how to use it, as well as about how to recognize, after the fact, enactments and their usefulness, when working with adults who have survived severe physical and childhood sexual abuse.

Monday, October 20, 2008

"Rethinking Psychotherapy and Psychoanalysis: What Does Feminism Have to Do With It?"

Lew Aron, PhD, a great, modern, psychoanalytic thinker and orator, visited Tampa on Saturday October 18, 2008 to share his critique on the historical evolution of psychoanalytic thinking, and on the contribution made to it by postmodern, deconstructive feminism. As we know from our clinical work, some beliefs have to be 'broken' to allow putting them back together in a new configuration. Never had I seen attendees at a Tampa Bay Psychoanalytic Society Scientific Meeting so abuzz with excitement as they embraced the iconoclastic thoughts put forth by Dr. Aron. Some of his points are as follows:

Aron urges that to understand the concept one must understand its context. When an author, Freud, for example, writes: whom is to be convinced by the paper, with whom is it in dialogue, with what is the author struggling?

After discussing how psychoanalysis today is in trouble (the aging out of analysts of the American Psychoanalytic Association, the paucity of candidates in training, the ever declining number of analytic patients), Dr. Aron notes how analysts can not even agree on the definition of what analysis is, nor on whom might benefit from it. There is an argument about the number of sessions per week, about sitting up or recumbency, about how much supportive work means it is no longer an analysis. Aron sees some of the arguments in history to be about economics and prestige.

Freud never differentiated between psychoanalysis and psychotherapy, but he did eschew hypnosis and suggestion, the latter having brought down his illustrious contemporary Charcot. Psychoanalysis has been so doctrinaire as to try to fit the patient to the theory/technique, instead of vice versa. Franz Alexander advocated for this flexibility and was summarily extricated from mainstream American psychoanalysis, accused of blurring the distinction between psychoanalysis and psychotherapy, and of ignoring psychoanalytic parameters (Eissler).

European emigrant analysts coming to the U.S. before WWII could afford more flexibility. But those who fled the Nazis, losing home, livelihood, family, may have recreated in the U.S. what had been lost, and so may have clung tenaciously to doctrine. Gill defined psychoanalysis as a therapy that when conducted by a neutral [as if exists] analyst leads to the unfolding (i.e. intrapsychic) regressive transference neurosis to be resolved by interpretation alone, or mostly.

Interpretation has been privileged as an active masculine penetration of the passive female unconscious (an idea which backs imperialism, colonialism, racism, homophobia, misogyny; and allows for conquering the inner world and beating down resistance, as one attendee noted). Likewise, autonomy has trumped dependency. Hartman and Rapaport argued for ego autonomy, i.e. analysis led to structural change; if take this parameter away, then one would rob patients of the ability to do for themselves. After all, successful outcome is measured by a patient's ability to continue in self-analysis, having internalized the analytic process and the analyst. Yet Wallerstein's 1954 study at Menniger "54 Lives in Treatment" showed the relationship to be mutative. (Kernberg, who ran the study, has noted that the main contribution of psychoanalysis to the world is psychoanalytic psychotherapy. [One attendee modified this to: it is psychoanalytic thinking that is its greatest contribution].) The implication: if psychoanalysis deals with the inner world and autonomy, then psychotherapy deals with behavioral change and transference cure.

Apparently, analysts have privileged autonomy, in part, because analysts like to be left alone! (Smith's study on the ideal patient). Autonomy is valued (but then how have a healthy dependent relationship, such as marriage?), and dependency feminized.

Freud's theories arose contemporaneously with the rise of antisemitism in Vienna. Freud feared people would say his ideas applied only to Jews. Rabbinical Jews idealized the studious, passive man, but, in a culture which conflated circumcision with castration, Germanic men did not want to be seen as passive and effeminate. Aron purports that when Freud said that the bedrock of psychoanalysis is the repudiation of femininity, Freud had to repudiate his culture's belief that Jewish men were feminine, passive, castrated. Using Greek mythology to bulwark his position, Freud advocated the opposite: a kind of 'I, like all men, am not passive, castrated or feminine (or homo erotically attracted to Fliess, nor willing to be so with Ferenczi) but, instead, I am Oedipus, aggressive, willing to murder (even my own father), attracted sexually only to women (even my own mother).' (Freud, if he believed it, he believed it to be universal.)

An important insertion: Freud never denied that sexual abuse occurred prevalently. He only denied that it was the etiology of hysterical neurosis. (Himself hysterical, he would be indicting his father.)

Freud had to defend this binary opposition between active/passive; male/female; (Goy/Jew) to save his science (psychoanalysis) and save himself. Historical acceptance of falling to one side of the polarity, this binary configuring, leaves no room for a third and the tension held between two polarities. Aron encourages us to refrain from investing in binaries, and encourages, instead, their deconstruction.

Accordingly, Aron cautions against the erroneous conflation of intensity of training with the intensity of treatment. Different from most of his contemporaries, Aron finds it a mistake to separate psychoanalytic and psychotherapy training. Instead, he recommends that candidates receive didactics and supervision, but that candidates learn for themselves the difference frequency (really the meaning of a particular frequency--loved, enslaved, dependent, special--to a particular patient) and intensity make for their patients, some seen on the couch, some in a chair. Most radically, he recommends that candidates choose their own therapy.

There seem to be only two things analysts agree upon: that there is an Unconscious (though not on what it is or how it works) and it is important to scrutinize the therapeutic relationship (though not on how or when). Aron quotes (L. Friedman) "monstrous" [like a gryphon or chimera?] to describe psychoanalysis. It does not fit one category well, not solely science, art, medicine, psychology, literature, cinema, quixotic, or cost-benefit soundness). Our fore thinkers were rebels, misfits, radicals, and reformists, living in a particular relationship to authority. Psychoanalysis has moved from the Golden Age of consensus, to pluralism.

This is an introductory program geared to provide clinicians with a theoretical framework that uses common sense language to describe dissociative processes and their vicissitudes.

Using selected videotapes from the clinical setting, Dr. Chefetz brings the participant into the consultation room to educate about the intensity of the affective disarray and the profound nature of shifts in subjectivity that regularly intrude upon the consciousness of persons with complex dissociative disorders. Dissociative processes are part and parcel of mental life, not just a production of severe trauma. This seminar will help participants learn to identify dissociative processes in both patient and therapist as a routine, but usually un-noticed, part of subjective experience.

Healing Haunted Lives: Trauma Workshop Series

4-part Trauma Series Workshop begins on October 25, 2008, starting off with Dr. Richard Chefetz who will elaborate on dissociation. The series will end on March 7, 2009 with Dr. Ghislaine Boulanger discussing herlongstanding work with Vietnam Veterans as well as more recent work with those intimately affected by the events of 9/11. Discounted registration will be available for attendance of the complete series.

Faculty, Institute of Contemporary Psychotherapy & Psychoanalysis, Washington School of Psychiatry, Modern Perspective inPsychoanalysis and New Directions in Psychoanalysis/Washington Center for Psychoanalysis; Distinguished Visiting Lecturer at theWilliam Alanson White Institute, NYC; past-president International Society for the Study of Trauma and Dissociation

Sunday, September 14, 2008

On Saturday, September 13, 2008 the Tampa Bay Psychoanalytic Society hosted their friend and colleague from Miami's Florida Psychoanalytic Institute and Society, Peggy Hutson, M.D. who has written extensively on Shame.

It is the discrepancy between one's self representations [who one thinks one is] and one's ego ideals [what one hopes to be] that leads to shame, she notes, deeply influencing self esteem and one's ability to have needs met. When self esteem diminishes, so does one's capacity for empathy. Ego ideals, housed in the superego, but separate from the "superego proper" (concerned with prohibition of drives), exercises a "need satisfying agency" (Freud) for good feelings about the self. One set of ego ideals is about gender. Some of these ideals are conscious, many are early introjections. Some are helpful, some hurtful, some considered the norm even when they are limiting.

Shame (as) Conflict was described. One difficulty that may arise, from a history of success leading to rejection by the envious, narcissistic primary object, is for one to feel shame when they do not succeed, but threatened with loss of safety and security (attachment) when they do. Also, when one envies an other: there may first be experienced a diminution of one's self esteem, with the signal affect of shame, followed by one coveting for oneself what the other has. One may then become adaptively ambitious. Or, without such an adaptation, envy may lead to aggression.

Dr Hutson notes that shame can be manifest in a variety of ways: as haughtiness or arrogance, snobbery, or over achieving, as denigration or envy. When the need for safety and security is threatened, one can react with rage. She distinguishes this threat from the threat to the cohesion of self. Early losses of safety and security, hearkening back to early separation difficulties, may, when present day experience threatens to repeat such a loss, lead to panic attacks. Severe anxiety can then lead to loss of cohesiveness.

When working with shame, Dr. Hutson employs analysis of the superego and of defense, such as projection, by using close process monitoring ( ala Paul Gray, based on Freud's psychic determinism). An example might be when a patient's criticism of and anger at another is immediately swept away by complaints of guilt (as a defense against the anger). Dr. Hutson also works with reruns/templates (transference) with the goal of achieving "transmuting internalizations."

While Dr. Hutson's talk on shame was appreciated, and she did note that gender ideals are "man-made," I personally was hoping to hear more about gender. Gender itself is a construct. Muriel Dimen (In Psychoanalytic Dialogues 1(3): 335-352) writes that gender has at its core "difference, not essence, the relationship between masculinity and femininity as culturally conceived, interpersonally negotiated, and intrapsychically experienced." A dialogue about gender would be welcomed by me at the Tampa Bay Psychoanalytic Society.

Thursday, September 11, 2008

Last Friday morning on National Public Radio's Story Corps, a life was truly celebrated through listening. A mom interviewed her son who had been a kindergartner on 9-11 and whose grandfather, her father, had died in the World Trade Center. This boy related with great equanimity good memories of his grandfather, such as pretend sword fighting as Peter Pan and Captain Hook. When his mother asked what he remembered about that day, 9-11, his voice became tearful as he recalled her distress. His mother asked about the trouble he had for awhile about falling asleep and how he had managed that. He said he had held on to his stuffed animal and thought of his grandfather as still alive.

I found this recording on NPR particularly moving both because of 9-11, and because I work with so many people who have experienced trauma. It illustrated both the importance of the emotional connection to the mother in cuing and helping a child navigate loss as well as the importance of transitional objects, whether toys or thoughts. Trauma for children is not simply the loss of a loving other, though this is sufficiently devastating, but can sometimes mean the literal, not just psychic, annihilation of self. The concomitant grief of the parent must include a model of surviving as well as allow for the maintaining of a stable enough connection between parent and child. It was wonderful of this mom to provide the space for grieving and for remembering together with her child.

Though not evident in the radio vignette, trauma is often accompanied by dissociation. In children it is used (particularly when it is the parent who has inflicted the trauma) to maintain the tie to the loved and much needed parent. In adults, dissociation can help to split off otherwise overwhelming affect (emotions). For the therapist, working with the many compartmentalized self representations of a patient who has experienced long term trauma takes a particular willingness to utilize (once they are discerned) projective identifications, to wear the attributes the patient lends us, and to participate in the reenactments that help bring to light the disavowed parts that must one day be owned.

As this work sometimes necessitates consultation, colleagues from the Tampa Bay Institute for Psychoanlytic Studies decided to invite a special kind of dialogue about Trauma to our town. A 4-part Trauma Series Workshop here begins on October 25, 2008, starting off with Dr. Richard Chefetz who will elaborate on dissociation. This Series ends on March 7, 2009 with Dr. GhislaineBoulanger talking about her longstanding work with Viet Nam Veterans as well as more recent work with those intimately affected by 9-11.

This now fateful anniversary always casts a somber shadow on my mood. I try to use it to recall the thoughts on that Tuesday, not the least of which is the reminder to try to cherish and respect those I love; to reevaluate, daily, choices about what (and who) is meaningful in my life; and to take some comfort in the fact that the work we do helps ameliorate somewhat some of the all too prevalent traumas.

Tuesday, September 2, 2008

I was impressed yesterday to learn that Gov. Palin has a five month old son with Down's Syndrome. Many an expectant mom would have made a different choice. My heart also goes out to Bristol Palin who is an expectant mom at age seventeen. I agree with the Governor's announcement that this is a difficult choice requiring lots of support. Today a young woman, still a child herself really, will need to contain an infant's raging, teach subjectivity to a toddler, and, later, help with homework perhaps alongside her own studies, and frankly discuss sex with her teen. I am so happy that just eighty-eight years ago women who had reached majority age were granted choice, to vote.

In February 2008 on this blog I reviewed the film "Juno" and asked the presumptous question of how an otherwise educated teen could find herself in the predicament of being unwantedly pregnant. I will not presume to ask such a question now, as the decision belies the wanting. (Many decades ago when I was a teen, the belief was that only "good" girls got pregnant because they were not planning to have sex, and so were unprepared---recognizing birth control is not 100%).

In our consulting rooms with our therapy patients, nothing is off limits to discuss. This, unfortunately, is not so in the personal forum nor the political arena. Not all teenage girls have a supportive, educated, or well to do family. Regardless, there are those girls who may not want to carry a pregnancy to full term. Palin, of course, wishes to over turn Roe v. Wade, and so lives by her convictions. I applaud those who do. In a world troubled by people and countries who find it hard to recognize the center of subjectivity inherent in each other's experiences, I do not, however, expect others to live as well by my convictions. Having daughters myself, I am for freedom of choice, for them, their bodies, and their dreams.

Thursday, August 21, 2008

A road, a journey, the myriad of metaphors for life or life experiences, and for an analyst, a metaphor for the experience of psychoanalysis itself. But the 2007 Pulitzer Prize winning novel The Road by Cormac McCarthy [who also won the National Book Award for All the Pretty Horses, (1992)], a book of "gratitude" dedicated to his young son John Francis, is almost too much to bear. I recall writing the film review, based on another of McCarthy's novels, No Country for Old Man, and alluding to psychoanalysis as no country for the faint of heart. The opening page of The Road had me reevaluating thinking myself of pretty strong constitution. McCarthy writes "the frailty of everything revealed at last."

I thought the novel might be describing the metaphoric annihilation of a severely depressed person, an existential angst par excellence of aloneness in a cruel world. The father in The Road says "if only my heart were a stone." And he recognizes that "he could not enkindle in the heart of the child what was ashes in his own." The Road is profoundly sad, but, unlike depression, beautiful. Tenderness and sacrifice evident in a yellow toy truck or a half packet of cocoa. Frighteningly, aliveness seemed to interrupt the relentless deadness only in passages that described a kind of kill-or-be-killed mentality, and a spark of love or tenderness almost too much to bear. I thought of patients who cut themselves.

There is a kind of 'be here now' to their lives, whether vigilant for marauders or a swim in a mountain pool. There is no past, and no place to be. The compelling reality is the search for food and for shoes.

The terse sentences, the paucity of dialogue, the bleakness, all reminded me of Hemingway, but, in The Road, evenwith the man sometimes dreaming of "aching blue" sky, or of his bride, or of flowering woods, there is no room here to entertain illusion, as Jake (The Sun Also Rises) thought Brett might, evident in his question to her, the book's last line: "Isn't it pretty to think so?" The Road has not a chapter, not a name (except Papa; and a name used as a lie); with almost every thing barren, sometimes not even a completed sentence, not an apostrophe, save one, for contractions, the daylight, grudging, the sun, indifferent. Corpses grimace, and the mummied dead are everywhere.

The boy is (understandably) frightened, alot. Perhaps the most heartbreaking of all is the recognition of what children in this (our) world always bear. The father, exhausted, irritable, tells his son, "You are not the one who has to worry about everything." The boy replies, "Yes, I am. I am the one."

Though the environs in The Road stand in stark contrast to descriptions of nature's lushness in McCarthy'sThe Orchard Keeper, I was nonetheless reminded by The Road of the journey of Inman, in Charles Frasier's Cold Mountain, on his intrepid trek, plodding through starvation, murdering marauders, and cold. But in The Road the man and his son trek through a nuclear winter of total destruction. If there is parallel devastation for Inman, it was what he thought became of goodness within himself, whereas the boy in The Road still carries the "fire" within, and his father believes this enough to keep them both alive against all odds for as long as necessary. Sometimes the analyst carries the belief inside, enough to propel analyst and analysand through the devastation. Sometimes it is the analysand who is responsible.

Perhaps in the last line of her NY Times review (Sep 25, 2006) of The Road, Janet Maslin said it best: "'The Road' offers nothing in the way of escape or comfort. But its fearless wisdom is more indelible than reassurance could ever be." Another Janet, Janet Malcom, might have written that about psychoanalysis, had she read The Road before writing The Impossible Profession.

A new study by two University of Chicago students has demonstrated that children ages 7 t0 12 years are hard-wired for empathy. Their MRI studies demonstrating their findings, with graphics MRI images, are at the above link. Their studies demonstrated that the areas of the brain associated with moral reasoning are activated when the children see pain inflicted upon others. These are similar to findings that have previously been demonstrated in adults.

Wednesday, July 9, 2008

SPLITS IN PSYCHOANALYTIC COMMUNITIES (AND IN TAMPA BAY)

By Arnold Z. Schneider, Ph.D., ABPP

JULY 9, 2008. Today marks the 6 month anniversary since a group of psychoanalysts and psychotherapists from TBIPS announced via an internet message that they were resigning from the parent group and initiating a new psychoanalytic-psychotherapy training program. There had been absolutely no discussion or warning of this thought or decision in the group as a whole of this forthcoming event despite the fact that it must have been the focus of many secretive meetings long before the event occurred. To my knowledge there has been no discussion between the two groups since the event occurred.

While I assume my share of the responsibility for what led up to this split - and it is most likely a major share - I do not believe it merited the abrupt decision, the non-discussion attitude, of the resigning group. Certainly, we all had a part in the split. I believe that a major reason for the split was the absence of our ability (willingness) to speak openly and directly about our feelings, about the process taking place in the group in which we all participated, and of our being unable (unwilling) to take responsibility for them. In this regard, I believe that most of us were following the dictates of our early training experiences and identifications which dictated that we remain opaque.

It is very interesting that our then President had handed out an article by Kenneth Eisold (1994) (someone I had urged us to invite as a consultant to (for) the group and had spoken with) shortly before the split took place. The following is a brief and incomplete review of his paper, The Intolerance of Diversity in Psychoanalytic Institutes. International Journal of Psychoanalysis, 75, 785-800. I believe it helps explain some of the reasons this unfortunate schism happened.

Splits (schisms, defections) within psychoanalytic communities have been common phenomena since the origin of psychoanalysis. Beginning with Freud and his splits from Jung, Adler, Forenczi, and others, the tradition has continued to include the five splits in this country (Washington/Baltimore, Philadelphia, Boston, Cleveland, and Los Angeles), and internationally in France, Germany, Austria, Sweden, Norway, Spain, Brazil, Mexico, Argentina, Venezuela, Columbia, and Australia (not to mention the struggles in England between Anna Freud and Melanie Klein). Also, there have been intense rivalries between the American Psychoanalytic Association and the International Psychoanalytic Association (eg., over the question of Lay Analysis) and within the Division of Psychoanalysis between Section 1 and Section 5.

There have been many attempts to understand and explain the origin and development of these painful splits, primarily focusing on the historical tradition, group functioning, social systems, organizations involved, individual (personality) factors, etc.. Narcissistic, superego, and “pathological” identification characteristics of the leaders are often cited as key elements in the dissolution of groups. While all of the rancorous aspects on both sides of the schism are part and parcel of these splits, in a paper published in 1994, Kenneth Eisold points to the dynamics of “social defence” --loneliness and intolerance-- as important aspects in the nature of analytic work of the analyst.

First, he points to the “nature of the work” (the isolation, loneliness, demands) which leave the analyst vulnerable to seek out a sense of certainty on his/her strict reliance on psychoanalytic theory (“loyalty”) , often connected to early training experiences, leaving out (defending against, rejecting, splitting off, dissociating) alternative theories.

A second factor, “The nature of membership” refers to the analyst’s need for acceptance by the group which plays itself out in such important issues as self-esteem, acceptance, referrals, etc.. The importance of belonging in each one of us -- for varied reasons -- is an incredibly important motivation. Belonging becomes interpreted (experienced) as a privilege and is reinforced by being the one who or a member of the group which rejects others (institute groups, theories, individuals). Eisold refers to the basis of this dynamic to be in the “pairing that goes on between patient and analyst (along generational lines) which leaves the organization experienced ambivalently “(Eisold adds “resented”). At the very same time, the need for a home often results in the diverting (displacement) of those negative feelings onto another group, theory, or analyst.

The third set of factors Eisold points to relates to the “psychoanalytic culture”. The analytic culture has been opposed to all other cultures (“I know what is best”) and, as a result, acts in an authoritarian (closed, one-person) way. Not only do they reject other theories, groups, etc., but they feel attacked (violated) by other ways of thinking. Consider the reaction of most early classical analysts toward the use of medication and contemporary models of psychoanalysis. Eisold labels this phenomenon “privileged apartness” .

I believe that all three of these factors were involved in this split. The need for certainty, the importance of belonging, and our culture were clearly factors which entered the group. There was little discussion of these factors among ourselves and, perhaps, little thought about how they were playing themselves out.

Eisold’s paper contains many more ideas and subtleties than I have expressed in this brief summary. I urge all to read it. Of course, each side of the schism contributes, and as he points out, the “bystander “ contributes as much as the victim or perpetrator. Where or when does the schism end? Never? How might it end? Certainly we analysts believe in the “talking cure”, but the “talking cure” is an intensely complicated process. The built in defensive, narcissistic, subjective, identificatory models are certainly important unconscious mechanisms which keep us all apart. ALL of us participate. I believe we must accept that these battles will continue through the life of psychoanalysis. There is no permanent repair or fix, but only for analysts of all persuasions to come to accept the ongoing cacophony of differing ideas, experiences, and perceptions and then use them in a dialogue with one another -- to be open to different understandings of the nature of the content and process. Psychoanalysis is clearly a science, an art and a philosophy and we must WORK TOWARD integrating these functions, knowing we will never get there. But we must all agree to work in that direction, not splitting off.

Certainly a “third” -- a consultant -- would have been quite a help; an analyst for the group and someone who could listen (in a relatively unbiased way) and therefore hear, see, experience, and shed light on that process. Certainly the consultant has to be expected to have his/her biases also, but perhaps the consultant could offer a “safe” place --a transitional space-- for all to enter and to work together (in the hailstorm of ideas). Differences will always remain, but perhaps with agreement --no, commitment-- by all to accept differences AND to continue to work together within the expected chaos, to look inside as to which role(s) one is acting out, to both openly verbalize and listen to what is being expressed and felt (as we expect of ourselves and our patients within a treatment process) we might not only survive, but excel!!! I believe the poignant aspect of Eisold’s paper --the simple humanity of the analyst-- must be recognized, accepted and appreciated. Each and every one of us has a past; each and every one of us exists with wounds, with loneliness, with defenses, with defects, with compromises. We expect our patients to talk about them. Why not us?

Emmanuel Berman (2004), a training analyst in the Israeli Psychoanalytic Institute, in his book, IMPOSSIBLE TRAINING; A RELATIONAL VIEW OF PSYCHOANALYTIC TRAINING, views the strength of an institute as being related to its openness to allow change and, therefore, allow growth. He points out that growth occurs through dialogue, disagreements, expression of varying ideas, and, importantly, an increasingly clear idea of what should and needs to be discussed. There have been many analysts who have been thinking and writing about this way of approaching such problems that we face.

Let me conclude these comments by quoting Eisold:

The social defence of intolerance--which ultimately leads to splitting--is, in effect, the final common pathway in which defences against the contradictions of the analyst’s identity, the internal tensions of analytic institutions and marginality of psychoanalytic culture in relation to the world join together to proffer an illusory security of sectarian life. …It is, on the other hand, constantly threatened by the danger of closed boundaries under the pressures I have attempted to point out; in that sense, it is threatened--and, I think, knows itself to be threatened--by the dangers of becoming a collection of cults (p. 796).

Sunday, May 25, 2008

Rupture and Repair and the 2008 Presidential CampaignKim Vaz, Ph.D., Chair of the Womens Studies Dept. at the University of South Florida, and advanced candidate in psychoanalytic training at the Tampa Bay Institute for Psychoanalytic Studies, shared with me recently some interesting insights about the presidential campaign, and about one candidate in particular, BarackObama.

Noting that our nation is in a crisis of identity, confronted by otherness, she sees parallels between Obama's stance and that of the analyst: If our nation is in a crisis, having to integrate the multiple selves/identities that are Americans--no longer the faceless of Montana or West Virginia--then Obama, Vaz says, asks us to look to him to "hold'' these "multiple identities that have fomented his imagination and his life of public service."

Obama tells us, as an analyst would, there will be 'ruptures.' And, like an analyst, Vaz notes, Obama tells us that though, 'not a perfect man, nor born of a perfect man, he will be, unlike his father, there, to listen, to learn, to lead, to fulfill promise.' "In other words," says Vaz, "there will be repair."

Vaz further notes that the 2008 campaign brings the "outsider identities of gender, age, and race" center stage. She expects, "We will need all our identities, foreign and U.S. born; male and female; old and young; black, white and brown, to solve the complex global problems America faces."

It was with great sadness that I read of the death of Dr. Charles Brenner on Monday, May 19, 2008. Dr. Brenner was my first supervisor during my training at NYPI. He was gentlemanly and generous, and he modeled for me the interminable patience that psychoanalytic work requires.

He was, as a supervisor, neither didactic nor pedantic. Instead, he patiently listened to me week after week, year after year, describe to him my first control case. He saw within two weeks the analysand's developing erotic transference. But he did not push the point. He wanted me to grow to see what was in the analysand's material (just as the analysand must develop readiness to see), and it took me --for whatever reasons--six months. It was an invaluable lesson. By his example, I learned to wait with my patients.

And he was unflappable. He listened with great equanimity. With both of those traits as a guidepost I live daily in my consulting room. While more contemporary thought informs me today, Br. Brenner's example remains with me, the foundation for listening to the narrative. His memory is cherished by me, and he will be missed by many.

Sunday, April 27, 2008

On April 26, 2008, Nancy Goodman, Ph.D. spoke to the Tampa Bay Psychoanalytic Society about "Love that Hurts: When Sadomasochism Organizes the Psyche." What was clear is that Goodman experienced the analysand's detachment and silences as sadistic; she felt "tortured." What was not clear was why this was theorized as an anal fixation or even as an intent to treat the analyst sadistically. It is true that the analysand had early childhood experiences that centered around the alimentary canal (power struggles: 'forced' feedings and enemas), but the connection between these early experiences, the material, and the theory was not made clear.

What was truly refreshing was the subsequent discussion, and the presentor's graciousness regarding genuine openness to other perspectives. The attendees seemed to emphasize the early misattunement between mother and child. Mother's controlling and intrusive behavior may have led the small child, who later appears "autistic" as an adult analysand, to detach, not as a sadistic manuever to control the object, but as a self-preservation to contain unbearable affect (Lewis Aron, who, by the way, will visit Tampa October 17, 2008). Goodman herself recognized that a fetish (she proposed that the object-relationship was itself a fetish in this case) was an attempt to "keep away disorganizing terror." [I do acknowledge the defense of 'turning the tables,' (or as a colleague once cogently slipped, "What comes around, goes around"), that this analysand's behavior could communicate to and engender in the analyst the feelings he had felt as a child vis a vis his mother. But I wondered, as did others, what participation by the analyst helped entrench for so long this dynamic between them?]

The audience also noted that when a mother treats a baby not as a baby, but as an object, this may be indicative of the mother's inability to participate in reverie and to hold the baby in her mind (Thomas Ogden), a problem noted in the analysis: it was as if the analyst did not feel held in the analysand's mind and felt objectified. Detachment was also considered by some attendees, not as anally sadistic, but instead as anaclitic, a reaction of depression from an infant whose needs are so ignored, or misunderstood.

Goodman repeatedly evoked disavowal ("a desire to disavow difference") but did not explore that this disavowal may have been a co-creation, e.g. when an analyst can not allow certain topics or affects to be explored because of her own discomfort, a discomfort which the analysand implicitly perceives through tone, facial expression, body language, etc. (Goodman did evoke Wilfred Bion's concept ("alpha" function), but did not connect it to the material presented, nor to recent research on right brain communication and implicit knowing.)

Christopher Bollas, referring to Freud's early cases, speculated that the erotic transference may have been an attempt to enliven the analyst (out of the stance of abstinence). If indeed sadistic, could there not also have been in this presented case the additional possibility that an analysand uses sadistic behavior as an attempt to search for the surviving other (D.W.Winnicott; Jessica Benjamin), an attempt to break through to the other (analyst)? The turning point in the analysis was seen to be when the analyst spontaneously expressed "shock" that the analysand was quitting treatment. Could this have been pivotal, in part, because the analysand could now perceive an (affective) effect on the analyst?

On a more personal note: When a presentation allows for such lively, interesting, and fun discussion, I applaud the group's ability to sustain the tension between differing ideas. Perhaps the Tampa Bay Psychoanalytic Society possesses within it, after all, the ability to refrain from privileging one theoretical perspective as more refreshing than other equally evocative and useful ones. I also applaud Goodman's ability to be open to do so.

How can psychoanalytic practitioners from diverse theoretical backgroundsmake use of new or different perspectives?

Dr. Arnold Schneider, an experienced psychoanalyst trained in the tradition of ego psychology, leads off this online series by inviting us to join him in his “work in progress.”

His engaging and insightful paper, written as an introductory presentation on psychoanalytic psychotherapy, highlights the basic phases and elements of the process using the lens of the traditional model that has formed the foundation of his practice. Only four years after writing it, Dr. Schneider takes the unusual and challenging step of using a forum like this to announce changes in his view of the analytic process. He welcomes us into a dialogue about possibilities for integrating contemporary approaches with traditional concepts and challenges us to think with him about what it means to evolve our psychoanalytic practice.Interactive Online Series:

During the next several weeks,

responses of all kinds from various analytic therapists will be posted online.

We want to hear your thoughts about what additions, deletions, changes, etc. you'd make to the paper ---

all clinical and theoretical views welcome!

Make comments or share your experiences – anonymously or owned – simply by clicking on the “COMMENTS” link at the end of each post. At the conclusion, the faculty of TBIPS will offer a summary of the dialogue and compile an outline for a new "co-created" paper.

Monday, April 14, 2008

There is something extremely puzzling to me. My hope is that, through discourse, I can come to better understand this question about analysis in the left brain (verbal, symbolization via language, logic-of sequence, explicit, etc) when growing evidence seats the Unconscious in the right brain (nonverbal, emotional-affective, bodily-based, relational, implicit). This 'crisis of faith' (really, of emphasis, or privileging of what is mutative) was triggered by my attendance at the American Psychological Association, Division 39 (psychoanalytic) over the weekend in NYC. Though I attended over 30 hours of presentations and discussions, I was most 'blown away' by the 50 minute lecture of Allan N. Schore, Ph.D. [of UCLA, author of "Affect Regulation and the Origin of the Self" and "Affect Regulation and the Reparation of the Self"] on April 12, 2008 entitled, "The Paradigm Shift: the Right Brain and the Relational Unconscious."

Schore is a neuropsychologist, so he talked about the brain. The most ancient part, the brainstem, oversees the automomic nervous system (think "automatic:" breathing and heart rate, fight-flight responses, etc), arousal, and pain. It interfaces with the limbic system (the seat of our emotions and libidinal and aggressive motivations), which, in turn, interfaces with the Right hemisphere. The right brain is bodily based, nonverbal, ultra-rapidly integrative of emotion, affect, facial expression, auditory prosodic, gestural, and other relational data, and is so rapid that this information processing is truly unconscious! It is the seat of implicit memory. In turn, the right brain interfaces with the left hemisphere, where explicit, verbal communication originates.

Early interactions between infant and caretaker regulate affect and self. The primary care-giver regulates the infant's bodily-based, affective arousal (the mind is not separate from the body). The infant brain actually develops according to relational, two-person, intersubjective experience! As most regulation is going on at the unconscious level, Schore recommends that analysis focus on recovery of affect-laden infantile experience, even dissociated affects.

As Schore states that 60% of communication is non-verbal (facial expression, posture, gestures, tone, prosody, pitch, inflection, etc), it makes one question how did psychoanalysis come to privilege left brain (explicit, verbal) communication? Because it is easier to quantify and understand consciously? [Some, including Lew Aron, who will visit us in Tampa October 17, 2008, and Jessica Benjamin theorize that the repudiation of feminity - designated as that which is relational and right brain, while language is designated masculine (think Lacan) - had something to do with the eschewing of right brain communication.]

I have to rethink how I will define psychoanalysis. Will my definition remain left brain lop-sided, privileging the revealing of the unconscious through reading between the (verbal) lines, or will I have to learn to value and make use of right brain communications? And am I doing that unconsciously already, unconscious to unconscious? Can this use of right brain unconscious even be taught or is it dependent on the infantile development of my own brain? Something besides insight from interpretation must be mutable, too, but how do we define it, learn it, understand it? Let me know what you think. I am grateful to Schore for giving me a basis to understand the clinical value of the elegant and painstaking research of Beebe and Lachmann on speech patterns and facial expression of the analyst. My children are grateful for any information that helps me pay more attention to tone.

"Norman Holland has, over a long career, explored how the human mind relates to literature."

"He is best known for his books concentrating psychoanalytic and cognitive psychology on literary questions: Psychoanalysis and Shakespeare (1966); The Dynamics of Literary Response (1968); Poems in Persons (1973); 5 Readers Reading (1975); Laughing (1982); The I (1985); The Brain of Robert Frost (1988); Holland's Guide to Psychoanalytic Psychology and Literature-and-Psychology (1990); and The Critical I (1992), an interrogation of contemporary literary theory through what we think we know about the way our minds work. "

Tuesday, March 18, 2008

The Tampa Bay Institute for Psychoanalytic Studies arranged for about thirty friends and colleagues to attend, then discuss, on March 15th, The American Stage Theater's production of Hamlet. While our group very much delighted in Todd Olson's enjoyable version, many of us were surprised by the depiction of Hamlet, not as a melancholic, but, instead, as a manic. The removal of Horatio from the script had the effect of leaving Hamlet with no trustworthy ear into which he could pour his angst. Consequently, the sense of tragedy (though all main characters are dead in the end) was lost, and, with the notable exception of the very effective rending of garments by Ophelia, Hamlet played almost entirely humorously.

In this quite truncated and up-dated version of Hamlet [perhaps necessarily so in order to appeal to modern day audiences who demand video-game/sit com/internet fast pace with little time devoted to reading], what was more noticeably lost was the beauty of Shakespearean meter, prose and poetry. The love of language is lost here.

Peter Rudnytsky, in his inimitable scholarly fashion, pointed out the use by Shakespeare of doubles and tragic ironies (e.g. that Hamlet is born on the day his father the King has killed King Fortinbras of Norway, only to have the kingdom of Denmark go to the son Fortinbras once Prince Hamlet, et al, are dead), many of which were lost by this shortened version. Please refer to the writings by Rudnytsky for further scholarship about this timeless play.

Tuesday, March 11, 2008

FILM: IdlewildIdlewild (2006,http://www.idlewildmovie.net/), written and directed by Bryan Barber, his first feature link film, will be shown on Saturday, March 15, 2008 at 9:00 a.m. in the Memorial Hospital's Auditorium (located in South Tampa on Swann Avenue, between Armenia and MacDill) by the local Tampa Bay Psychoanalytic Society. Following the film, Drs. Kim Vaz, Lycia Alexander-Guerra, and John Hartman, who have written a paper on the film about sadism, misogyny, and gang participation, will give a brief psychoanalytic presentation before leading a discussion of the film with attendees.

Idlewild stars Andre Benjamin and Antwan Patton, aka Andre 3000 and Big Boi of the hip-hop group Outkast, whose music videos Barber directed, as Percival and Rooster, respectively. Idlewild follows these two boyhood friends, both motherless, into adulthood in the small, Prohibition-era, town of Idlewild, GA. While Rooster has a surrogate father in Spats (Ving Rhames), a wealthy bootlegger who values Rooster's mathematical acumen and street smarts, Percival, son of Percy Jenkins, the town's well-to-do mortician, goes unacknowledged by his father except as a needed domestic at home and apprentice in the family business where the dead are to be made to look "peaceful, not happy."

But Percival received piano lessons from his strict aunt, and it is, in adulthood, music which is the common ground shared by Percival and Rooster. Rooster, bootlegger by day, sing and performs at the town's popular speak easy, ironically called "Church," where Rooster carouse with women (much to the dismay of Zora, his wife and mother of his daughters). Percival, mortician by day, plays piano at "Church" by night, where he, like the knight at King Arthur's court, keeps his distance fom the "floozies" there, and is, consequently, ridiculed by the other men.

Rooster is caught up in the gangsta scene, but has found a mother in Zora. Percival falls for Angel Davenport, a singer, and shares his original songs with her. (It is interesting to note that none, save Percival, use their real names, but instead go by Ace or Trumpy or Spats or Monk or G.W.)

One of the many treats of this film is its use of multiple segue as it parallels the lives of Percival and Rooster; e.g. Angel knocks at Percival's door and then Rooster walks through Rose's door; or Angel walks to the cab, then Rose gets into the cab; or Percival is saying 'hello' and Rooster in another scene says 'goodbye.' Percival literally saveds Rooster's life, and then Rooster saves Percival's.

Another jewel in Idlewild is the weaving of symbols which are multiply determined in meaning, e.g. the use of a butterfly: To demonstrate how Percival longs to be free of Idlewild, a butterfly travels from his mother's sunlit headstone, across the idyllic cemetary, and onto the window sill of the room where young Percival is imprisoned for piano lessons. Later, when Percival kisses Angel and they make love, 'hey, butterfly' plays on the soundtrack.

Percival has his Angel, and Rooster has his own angel in Mother Hopkins (Cicely Tyson). Both angels serve to free/redeem the men, one, from inhibition to success away from Idlewild, the other, from a life of disrepute back to legitimate business and family.

The psychoanalytic jewels will be elaborated at the discussion on March 15th. Dr. Vaz will talk about male appropriation of the maternal, Dr. Alexander-Guerra, about the loss of the maternal, and Dr. Hartman, about the dream sequence (a kind of dream within a dream, or, as in Hamlet, a play within a play). Speaking of Shakespeare, Percival's recurring refrain as narrator is "All the world's a stage..." (from As You Like It).

And after Idlewild, another psychoanalytic organization, the Tampa Bay Institute for Psychoanalytic Studies contines a day at the arts across the bay with Hamlet.THEATER: Hamlethttp://tbips.blogspot.com/2008/02/afternoon-at-theatre.htmlThough March 15th is the Ides of March, the Tampa Bay Institute for Psychoanalytic Studies will be sponsoring an outing, not to Julius Ceaser, but to Hamlet. After the 3:00 p.m. matinee of Hamlet at the American Stage Theater (see reviews in local St. Petersburg Times and Tampa Tribuneby John Bancroft and Kathy Greenberg, respectively), at 211 3rd Street South, in St. Petersburg, FL (727-823-PLAY, Click Here for Directions), interested parties will continue at the nearby Parkshore Grill for discussion and dinner with Peter Rudnytsky, Ph.D., Shakespearean Scholar at University of Florida, Gainesville, and Editor of Imago.To whet your appetite for the psychoanalytic discussion, consider some of the following musings:We are all familiar with Freud's idea that Hamlet hesitates to avenge his father's death because Claudius' acts have rekindled Hamlet's own infantile (Oedipal) wishes to kill his father and marry his mother. (He is freed to act after Gertrude dies.) Is Hamlet's infantile fear of the abandoning or engulfing mother not also reawakened by absence of his father and by confrontation with Gertrude's otherness as a sexual being? Must he remake his mother as a 'good lady' without sexuality to restore the lost parents?

Must Hamlet split or distort his parental objects to maintain narcissism, with its conflict of passage of authority from the dead father's generation to that of the son's? Is the universal experience of disappointment in the imperfect parent and the discovery of the subjectivity of the object such that the parents of the imagination must die a violent death?

Does Hamlet, having idealized his biological parents and internalized these idealized objects to solidify his own identity, now struggle with confusion, self-revulsion, and guilt when forced to confront the bad objects of his parentage? And to regain the good object mother, must he incorporate Claudius in order to wrest her from Claudius, or, to regain Gertrude, must he merge with the maternal object in death? (death by poison is, after all, a death from the inside)

Is the murdered king's Ghost a projection of disavowed parts of Hamlet's self, allowing voice to Hamlet's ambivalence about his mother and uncle?

Does Hamlet project his aggression onto others (e.g. Ophelia and Polonius) in his creulty?Does he struggle for his own agency, instead of impotent words, when condemning Ophelia to a nunnery or joining her in her grave? Does Ophelia, now dead, serve as a projection of others with the capacity to arouse fear as the uncanny/able to see what could not be seen?

Does Gertrude, in violating mourning with the festivities of a marriage, seem, to Hamlet, to legitimize Claudius, thus barring Hamlet's agency, and violating his father's legacy? Does Gertrude, outside the patriarchal order, in death, free Hamlet, while Denmark falls into enemy hands? Is Gertrude the object of desire or the cause of it?

Would the Jungians see Polonius as an archetype of the wise old man or an ambitious fool. Both Polonius and Hamlet, in death, are sacrificed/scapegoated.

Has the death of Rosencrantz and Guildenstern symbolized Hamlet's attempt to kill off his childhood and take on manhood? Is he calm at play's end because he has recognized this sought after agency? Or, as structural psychology might dictate, is Hamlet calm because his superego has now taken revenge on Hamlet's ego/self?

Just a few thoughts before we enjoy the production. Post your musings, anonymously or owned, by hitting 'comments' at the end of this article.

Wednesday, February 27, 2008

Susan Sands identified herself as a relational clinician whose work is grounded in self psychology. I was impressed with her ability to examine how self psychology may fall short of understanding some patients. I had been drawn to self psychology because it purports an empathic immersion with the patient. I previously understood this empathic stance as one of the most mutative elements of analysis. Her article made a sound argument that the empathic immersion is with the patient’s ego (concordant identification). Sands cautioned that self psychology is at risk of missing an important aspect of the patient’s internal world, namely the internalized objects (complementary identification). This article challenged me to re-examine my previous theoretical stance in order to more fully understand the patient.

Sands argued that the analyst may miss the countertransference in the empathic immersion. The analyst may be blinded from recognizing when the identification is with the patient’s internal objects (complementary identification) rather than the patient’s ego (concordant identification). The article emphasized that patients have a desire to be fully understood; including their disavowed affective experiences. Sands contends that empathic immersion promotes understanding only one aspect of the identification.

After consideration of the article, I continue to believe empathic immersion is a helpful tool for concordant identification with the patient. With this immersion I can gain greater understanding of the patient’s ego. However, I am left without an understanding of the patient’s internalized objects, namely complementary identification. This article challenges me to receive the patient’s experience of disavowed affect in order for complementary identification to occur. I believe projective identification is a useful tool for receiving the experience. The transformative element will occur when I can receive the projection, contain the experience, survive it, and then offer something different to the patient. The article builds a strong case for using the empathic immersion of self psychology while maintaining an open container for receiving the projection. If I offer a space that allows for both concordant and complementary identification there is a greater chance that the treatment will be mutative.

ReferencesSands, S.H. (1997). Self Psychology and Projective Identification—Whither Shall They Meet? A Reply to the Editors (1995). Psychoanal. Dial., 7:651-668Jacqueline Roller, PsyD attends the New Directions program in psychoanalytic writing at the Washington Center for Psychoanalysis in Washington D.C. and is in private practice in Sarasota, Florida.

Saturday, February 23, 2008

Christopher Bollas in Tampa

on Free Association and the Logic of Sequence

If the measure of our interpretations is the subsequent enhancement of facilitating the patient's narrative, free associations, and new material, then Christopher Bollas, hosted today in Tampa by the Contemporary Institute (Sarasota, FL), can not be found wanting. His presentation today generated "redolent" discussion on breaks, at lunch, even in the car pool home. Bollas declared himself a Freudian, noting that there are many Sigmund Freuds, depending on whom one asks. His model is pluralism and what comes to mind is based on the clinical material at hand [conflated inevitably with what the analyst has learned from theory]. Bollas is a Freudian in the classical sense of following Freud's privileging of analytic tasks of surrendering one's self to one's own unconscious in evenly suspended attention, not trying to fix in memory anything the analyst has heard, but rather in attempt to catch the patient's unconscious with the analyst's own unconscious. This is different from, what Bollas says is, the ego psychologist's having even temperament and being attentive. Bollas does not believe that what passes for classical analysis (the neutral blank screen who says little) is really what Freud meant, that is, is not really classical.

Bollas is especially laudatory about The Interpretation of Dreams because, in it, Freud recognizes that dreaming is another form of thinking, and that in Freud's having asked his patient to give their thoughts about specific dream elements, Freud discovered the value of the technique of free association. Bollas thought dreaming might actually be the most sophisticated and significant form of thinking that humans possess, for in dreaming, we can condense a multiplicity of ideas into a single image and express a simultaneity of a plenitude of thoughts. This remarkable ability of the mind is what inspires art, music, poetry. To interpret in the here-and-now is impossible because there are too many simultaneous levels happening in any given moment.

Freud understood that if one listened long enough to the patient's free associations, a pattern would emerge, a pattern that linked seemingly unlinkable thoughts. This is the logic of sequence [juxtaposition, contiguity]. (If content A is followed by content B, then this is read as AB.) And the unconscious mind functions with this logic! But, the patient needed to be instructed to be completely honest and not hold back even seemingly nonsensical, unimportant, or irrelevant thoughts.

Bollas added that Americans, as a culture, do not know how to free associate, whereas Europeans do. Americans communicate in and accept phatic [meaningless, insignificant, importless] language, only sharing a social reality but not really communicating. Therefore, analysands need to be instructed how to produce their narrative in a more meaningful way. [I had a difficult time reconciling this idea with evenly suspended attention and the faith in my unconscious being able to communicate with my patient's unconscious, but I invite explanations, please.] Later, he said all people free associate, that the unconscious poses questions, then comes to insights on its own, if we don't impede their free association with our comments. [I am aware of neuropsych research that shows the mind, particularly in dreams, does just that, organizing and problem solving.] It was noted that free association, in allowing the patient liberty to let the unconscious do its thing (as well as patient having become an attentive and dispassionate observer, too), is curative in itself, that is, comes to its own insights.

So when does the analyst make a comment? When the free associations indicate that the analyst's conclusion are evident. When the material at hand indicates and when the analyst is following the line of thought of the analysand. The purpose of listening (and interpretting), Bollas says, is to gain greater access to unconscious processes.

In a most illustrative way, Bollas gave a verbatim session of a supervised case. (He asked the attendees to free associate to the material [with which we complied so well, acting as patients, that we ignored the point of the lecture: finding the unconscious processes in the sequence of the material, or acting like analysts]. ) He then discerned aloud what the unconscious connections were thought to be, relying on the patient's associations, and the logic of sequence, as the evidence. It deserves reiteration: the analyst's conclusions are based on evidence from the patient's associations. This is why we must avoid interfering with the patient's associations.

These are just some of the thoughts after this stimulating and generative day. Let's hear from some of the other attendees. There was so much going on at one time, one can not possibly associate to every element in today's exciting workshop.

Friday, February 22, 2008

Here's another surprise (or, sleeper) of a delightful little comedy that garnered four Oscar nominations : best picture, director-Jason Reitman ("Thank You for Smoking"), actress- Ellen Page ("Hard Candy"), and original screenplay--Diablo Cody).

Juno is courageously idiosyncratic. Neither I nor my friends in high school could boast the kind of poise, level of quips and sarcasm, or the equanimity that Juno can. But we had heard of birth control. This is an entertaining film for adults but most of the struggle of a teen in this situation was far too subtle and adumbrated by the glib humor. I would definitely heed the PG-13 warning and not allow pre-teens to see this movie. Even with older teens, I would then discuss the content.

For all the luminosity of Ellen Page, I found myself most enamored of her down to earth, HONEST-with-themselves parents. The most poignant moment was when Juno, in contrast to the teens who know-it-all, admits, "I don't really know what kind of girl I am." Some thought Jennifer Garner as the perspective adoptive mother Vanessa was moving as she talked to the fetus through Juno's abdominal wall. I was more impressed with her more realistic portrayal of a first time mother, painfully awkward and unsure of her self. I might have been reluctant to choose an adoptive mom who was so rigid and seemingly up-tight and proper. Perhaps Juno thought Vanessa a welcome contrast to her own biologic mother, who seemed a bit eccentric and clueless, sending cactus as a gift year after year.

I liked the honest portrayal of girls, too, being interested and curious about sex, no Persephone having to be kidnapped to be sexual. I just don't understand why the movie did not allow for better understanding of the motives behind two smart teens, who know where babies come from, doing something so cavalierly. The matter of fact way they handled the outcome was a bit eerie. But I guess any difficult situation is fair game for humor. And I laughed a lot at this movie. I was just surprised about all the nominations.

Tuesday, February 19, 2008

THE OSCARS ARE COMINGMichael Clayton

Kudos to Michael Clayton for showing in an accurate light the symptoms of a person who suffers with bipolar affective disorder. But was the change of heart and integrity of Arthur Edens (Tom Wilkinson) only the result of going off medication? The protagonist, same name as the movie's title, certainly was more anguished in his choice to do the right thing. That Michael Clayton has been nominated for an Oscar for best picture makes this movie, to me, a sleeper (in fact, I dozed off in parts), the fine Tom Wilkinson and marvelous Tilda Swinton performances not with standing. One colleague thought it made the list because it speaks about the corruption, even willingness to kill, of contemporary corporate America, in particular, the Bush administration. I don't know.

Written ("Bourne" trilogy) and directed (first time) by Tony Gilroy, it is in the genre of John Grisholm and intelligently suspenseful. It is a story about one man's (Clayton's, played by George Clooney) redemption. But unlike "Atonement," this main character is so covered in figurative mud it is easy to believe he had to be pushed into doing the right thing. Clayton says of himself, when a client hopes he can get off scott-free after a hit-and-run , "I'm not a miracle worker, I'm a janitor." Clayton cleans up the messes of his law firm's senior partners and of their clients. In this case, Edens, defending an agri-giant with a poisonous product in a $3 billion law suit, has decided to go over to the righteous plantiffs' side and to reveal documents which seal his client's culpability. Unethical for a lawyer, perhaps Edens invokes a higher judge. "I have blood on my hands!" and "I am an accomplice!" Edens tells Clayton. Edens was inspired by one plaintiff, Anna: "She's a miracle, a perfect little creature," whose parents are dead and whose brother is dying (think Erin Brockovitz and Changing Lanes).

But the movie isn't about Edens (or Eden). It's about the lengths people wil go to to protect their own (greedy) interests and about Clayton's change of heart. It was difficult, though I am in that business, to understand how Clayton is finally led to change. Perhaps it was his tenuous, though valued, relationship with his son, just as Edens may have seen his daughter in Anna, that helped both men strive to make the world a safer place, or, at least, to hold accountable those who poison the world. Perhaps it was the loss of a valued friend and mentor that was the last straw for Clayton. The other characters showed no shortage of a deficiency in putting themselves in another's shoes. But that is a hard thing for all of us.

Protecting one's interests reminds me of Jessica Benjamin's work (see "It Takes Two..." posted on this Blog on February 6, 2008.) How very difficult it is to put oneself in the other person's shoes, that is to say how easy it is to dehumanize, if only momentarily, another person to that of an object for one's own devices. (Anton Chigurh "No Country for Old Men" was on such an inhuman mission, and was unrelenting. Daniel Plainview "There Will Be Blood" sometimes connected with his adopted son and had to struggle to stay disconnected from his past and from his longing for family).

Change of heart? Isn't that a welcome by-product of psychoanalytic psychotherapy? New York Times writer Manohla Dargis said of Clayton's legal morass "an abyss, largely of our own making." Don't our patients, with us, sometimes discover that they have more freedom than here-to-fore realized to make changes which invite more joy and peace into their lives?

Monday, February 18, 2008

The Financial Times of London, reporting on the recent Boston meeting of the American Association for the Advancement of Science (AAAS), cites recent studies from several American universities that show that neural development is interfered with in children growing up in conditions of poverty. This effect is thought to be due to unhealthy levels of stress hormones, and is above and beyond any damage caused by poor nutrition and/or exposure to toxins. These studies were done at the University of Pennsylvania and Harvard, and show the pervasive harm is greatest during brain development between the ages of six months and three years. The director of Harvard's center on the developing child, Prof. Jack Shonkoff, said "the foundation of all social problems later in life takes place in the early years." Excessive levels of these stress hormones disrupt the formation of synaptic connections in the developing brain, and "literally disrupt the brain architecture." The scientists think that this neurocognitive damage is why programs such as Head Start have produced only modest results.

Paul Krugman, writing in the New York Times on February 18, has a poignant column titled "Poverty is Poison" and cites that 17.4 percent of children in America lived below the poverty line in 2006. He faults the governmental shift to the right, since LBJ's "War on Poverty" with its de-emphasis on combatting poverty, for the worsening problem. His very touching article can be found at:

These are important considerations to bear in mind in working with patients and clients who may have grown up in conditions of poverty - as well as in our social and political thinking. The societal consequences are broad and deep and long-lasting.

Sunday, February 17, 2008

An Interview with Owen Renik, MD

by Randall C. Wyatt, PhD and Victor Yalom, PhD on Psychotherapy.net

"The concept of resistance presupposes that the therapist has a superior knowledge of what is going to be good for the patient, that trumps the patient—which is disastrous—rather than constantly negotiated for the best in a dialogue between patient and therapist."

Owen Renik, MD, is currently a Training and Supervising Analyst at the San Francisco Psychoanalytic Society. He was Editor in Chief of the Psychoanalytic Quarterly for ten years, Program Chair of the American Psychoanalytic Association for two terms, and served as Director of Training and Associate Chief of the Department of Psychiatry at Mount Zion Hospital, San Francisco. He maintains a private practice in San Francisco.Source: Psychotherapy.net

This cinemagraphic pleasure is nominated for seven Oscars including best picture, best supporting actress (13 year-old Saoirse Ronan, who plays young Briony), best cinematography, and best adapted (from Ian McEvan's novel) screenplay. Directed by Joe Wright, it won the Golden Globe 2007 for best picture, and Kiera Knightly garnered the Globe for best actress. Freudians won't be able to avoid conflating Briony's girlhood crush on Robbie (James McAvoy), the housekeeper's son, and her witness of her older sister Cecilia's (Kiera Knightley) sexual relationship with him, with an oedipal triangle.

Briony, as a much older woman (Vanessa Redgrave), has written her last novel: about those long ago, family events, but conceived with a happier ending in order to give back, in fiction, what she had stolen from the lovers in real life. This happier, fictional spin is how many patients arrive in our offices, and the therapeutic work becomes its antithesis. Therapeutic work is not to justify some truth to childhood unhappiness, but rather to bring to light the fiction (erroneous beliefs) that is a child's explanation of events (written with a child's limited experience, cognitive maturity, and perspective) which amplify unhappy experience. It is to rework the narrative into a more realistic, more forgiving one. The grown up Briony entitles her novel "Atonement" precisely because she feels guilty. While she may, as a child, have known Robbie was no rapist, or may have conflated the coitus in the library with the rape on the grounds, she comes to realize her mistake. What may have been harder for her to forgive in herself was that her crush on Robbie motivated her vengeance. It doesn't take Freud to figure out that Briony (and Cecilia) devote themselves as nurses to wounded soldiers, both to be closer to Robbie away in the war, and also, for Briony, to assauge her guilt.

Where A.O. Smith of the New York Times writes of "the film's failure to find a strong connection between the fates of the characters and the ideas and historical events that swirl around them," I see this "failure" as an accurate depiction of how historical events, for most of us, are overshadowed by the emotional primacy, particular to our personal relationships, which lives in the human psyche. This film is worth seeing for it's richness in scenes and psyche, but it is not my pick for best pic.

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Welcome to "Contemporary Psychoanalytic Musings," the blog of the Tampa Bay Institute for Psychoanalytic Studiesor, as it is conveniently known, T-BIPS. We invite you to post your comments on psychoanalysis and books, film, conferences, the media, art, theory, clinical situations, current controversies, social issues, and anything else as seen through a psychoanalytic lens. We look forward to a spirited dialogue with you.Lycia Alexander-Guerra, M.D.TBIPS PresidentGabcast! Welcome! #3

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In 2005 a group of psychoanalysts & psychoanalytic psychotherapists convened to explore possibilities for meeting the educational needs of clinical professionals in the Tampa Bay area. Out of those discussions evolved a new institute, the Tampa Bay Institute for Psychoanalytic Studies. Consistent with the spirit of collegiality, openness, and diversity that inspired its development, the new Institute is non-authoritarian and democratic. Training programs utilize progressive and classical concepts which have been endorsed by contemporary critiques of psychoanalytic education. Believing that the capacity to think psychoanalytically best develops in an atmosphere of inquiry, open dialogue, and active participation the founding members sought to integrate these values into the structure of the new Institute and into the process of training. A precedent of collaboration and mutual respect for the contributions of all faculty and candidates was established enabling our mission to gain immediate representation in our actions.